Provider Demographics
NPI:1811756067
Name:GOODMAN, HANNAH M (RD, CD-N)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:RD, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N BROOKSVALE RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3337
Mailing Address - Country:US
Mailing Address - Phone:570-573-4760
Mailing Address - Fax:
Practice Address - Street 1:280 N BROOKSVALE RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3337
Practice Address - Country:US
Practice Address - Phone:570-573-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.002170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered